Pro Fee Coding Specialist - PFS Physician

Pro Fee Coding Specialist - PFS Physician Miamisburg, OH Job Details Full-time 1 day ago Qualifications Anatomy knowledge Medical coding compliance oversight RHIA Research Mid-level RHIT High school diploma or GED Certified Professional Coder CMS regulatory compliance EMR/EHR Certified Coding Specialist Centers for Medicare and Medicaid Services (CMS) Medical billing Computer skills Medical claim denial management Medical terminology Documentation review Communication skills

Full Job Description Job Details:

PFS Physician | Remote | Full-Time |

First Shift Responsibilities & Requirements:

This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance and EPIC WQ Reconciliation. KPN Pro Fee Coding Specialist Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and

CMS NCCI

edits Accurately assess documentation in

EPIC EMR

to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy] Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and

CMS NCCI

edits Corresponds with providers on pending claims to facilitate resolution Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies Communicate appropriately with providers, leaders, and staff Researches and resolves concerns timely

Educational Requirements:

High School Diploma or equivalent RHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certification Prior experience in professional fee coding/billing

Knowledge and Skill:

CPT, HCPCS, Modifiers, ICD-10, and

CMS NCCI

Edits Medical Terminology and Anatomy & Physiology Computer and EPIC Applications Excellent verbal and written communication skills

Abilities:

Charge Review WQ [Edits] Reviews, researches and responds to Charge Review WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. Demonstrates knowledge of CPT, HCPCS, ICD-10 and

CMS NCCI

edits Claim Edit WQ [Edits] Reviews, researches and responds to Claim Edit WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. Demonstrates knowledge of CPT, HCPCS, ICD-10 and

CMS NCCI

edits Follow Up WQ [Denials] Reviews, researches and responds to Follow Up WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. Demonstrates knowledge of CPT, HCPCS, ICD-10 and

CMS NCCI

edits Departmental Responsibilities Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and

CMS NCCI

edits Follow procedures pertaining to position Researches and resolves concerns timely

Overview:

Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it's by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.